Reducing Duration of Untreated Psychosis Through Rapid Identification and Engagem

描述（由申请人提供）：减少未经治疗的精神病（DUP）的持续时间是改善首次精神病（FEP）年轻人长期结局的主要目标。美国的“FEP护理标准”侧重于针对性的提供者教育1，内容涉及早期精神病的体征和症状，以激励患者转介到FEP服务，然后在主要以诊所为基础的环境中启动服务2。早期诊断和预防性治疗（EDAPT）FEP专业计划的经验。萨克拉门托的戴维斯已经确定了减少DUP的两个重要瓶颈，这与其他FEP诊所的文献报告一致。这些是1）转诊来源识别精神病症状的延迟，以及2）患者参与专业FEP护理的延迟或中断。基于萨克拉门托地区20个研究中心（学校/大学、急诊室/住院医院、门诊心理健康、初级保健）的全面和成熟的转诊网络，我们将使用两阶段、整群随机设计解决患者识别和参与延迟问题。我们将连续测试两种干预措施对减少DUP的影响，DUP在本RFA中定义为从首次出现精神病症状到参与FEP专科护理的时间。为了解决识别延迟问题，我们将研究使用标准的有针对性的提供者教育加上新技术增强的筛查，与单独使用标准的有针对性的提供者教育相比，测试教育加上技术增强的筛查将在疾病早期识别更多患者的假设。为了解决参与延迟问题，我们将比较使用移动的基于社区的远程精神病学增强型参与团队与标准的基于诊所的程序，用于接收、参与和启动治疗，以检验以下假设：移动的方法有助于更早和更稳定的参与，从而减少DUP。拟议的工作将提供新的具体的循证实践，以减少DUP，并通过对首次精神病发作的个人进行专业护理来改善结果。

DESCRIPTION (provided by applicant): Reducing Duration of Untreated Psychosis (DUP) is a primary goal for improving long-term outcomes in young people with a first episode of psychosis (FEP). The "standard of FEP care" within the US focuses on targeted provider education1 regarding signs and symptoms of early psychosis to motivate patient referrals to FEP services, followed by initiation of services within largely clinic-based settings 2. Experience at the Early Diagnosis and Preventive Treatment (EDAPT) FEP specialty program at U.C. Davis in Sacramento has identified two important bottlenecks to reducing DUP, consistent with reports in the literature from other FEP clinics. These are 1) delays in the identification of psychotic symptoms by referral sources, and 2) delays or disruptions of patient engagement in specialty FEP care. Building upon a comprehensive and established referral network of 20 sites across the Sacramento area (schools/universities, ER/inpatient hospitals, outpatient mental health, primary care), we will address delays in patient identification and engagement using a two- phase, cluster randomized design. We will consecutively test the impact of two interventions to reduce DUP, defined in this RFA as time from first onset of psychotic symptoms to engagement in FEP specialty care. To address identification delays, we will examine the use of standard targeted provider education plus novel technology-enhanced screening compared to standard targeted provider education alone, testing the hypothesis that the education plus technology-enhanced screening will identify more patients, earlier in their illness. To address engagement delays, we will compare the use of a mobile community-based, telepsychiatry- enhanced engagement team to standard clinic-based procedures for intake, engagement and initiation of treatment, to test the hypothesis that the mobile approach facilitates earlier and more stable engagement, thereby reducing DUP. The proposed work will provide new specific evidence-based practices for reducing DUP and improving outcomes through specialty care of individuals with a first episode of psychosis.